Defibrillators (Availability) Bill 2018

Onkar Sahota: On January 25, MPs will consider the Defibrillators (Availability) bill at its second reading. This ten-minute rule bill put forward by Maria Caulfield MP would require provision of defibrillators in schools, leisure, sports and other public facilities, as well asprovision for the training of persons to operate defibrillators, andfunding the acquisition, installation, use and maintenance of defibrillators. This would ensure life-saving equipment is available within the narrow time window of opportunity to save the victim of a sudden cardiac arrest.
Will you a) encourage London MPs to be in Parliament to support this bill and b) share information about the importance of defibrillators with London boroughs and other relevant bodies named in the bill?

The Mayor: I know that rapid defibrillation can make the difference between life and death for people suffering a sudden out-of-hospital cardiac arrest. Since the year 2000, the London Ambulance Service has introduced over 5000 additional defibrillators at community locations around London where cardiac arrests are most likely to occur. Within the GLA Group, front-line Metropolitan Police staff undertake annual training in emergency life support and all 660 police response cars are equipped with defibrillators and can be dispatched to treat cardiac arrest patients. Defibrillators are also installed at 180 Tube stations.
However, we can and should do more. I am very keen to see defibrillators more widely available across London, with greater public awareness of their location and confidence in their use. I am currently working with colleagues in the London Ambulance Service, NHS England, the British Heart Foundation and local authorities to explore how we might scale up this vital work in London.

Brexit- Decline in EU Nurse Numbers

Navin Shah: According to the research by the Royal College of Nursing, there is some 42% reduction in the number of nurses coming to London since the Brexit vote. Without the adequate nursing staff NHS would have problems providing safe and effective care. What should the government do and what plans should London have should the government fail to alter its proposed immigration policies which undermine low salaried workers such as nurses?

The Mayor: London relies more heavily on international staff than anywhere else in England, comprising 26 per cent of London’s NHS workforce and 41 per cent of London’s Nurses.
The NHS Long Term Plan aims to increase nursing numbers through expansion of undergraduate nursing places, new routes into nursing and a new online degree. Local areas will be developing five-year health and care plans that will include workforce. Publication of a national workforce plan is expected in the coming months.
The Government’s Immigration White Paper did not address the concerns that I and others have raised. Restricting future immigration to people earning over £30,000 won’t allow London to continue to provide crucial public services, including health and care. I have written to the Home Secretary to outline my concerns.
In the absence of a general election, withdrawing article 50 would allow time for a public vote to be held so the country can decide what course it wants to take and avoid the risk of a no-deal Brexit. The real tragedy of Brexit is that the prime minister has wasted the last 18 months pursuing a Brexit deal that she knew she would not be able to unite her party around, let alone the country – at the expense of focussing on the NHS, social care, education and policing.

Improving the mental health of young people

Onkar Sahota: A report from the Children’s Commissioner published on 28 November highlighted the poor performance of child and adolescent mental health services (CAMHS) in London. A recent survey of GPs underlined this as overwhelming majorities of family doctors did not believe their patients would be supported by local CAMHS. What programmes will you run to improve the mental health of young people in the coming year?

The Mayor: I have prioritised what I can do to support young people, but this does not take away the need for good local CAMHS. My Healthy Schools London Programme supports the role all schools need to play, I am working with the NHS and Local Government to promote their efforts www.london.gov.uk/mental-health-school.
I will continue the roll out of Youth Mental Health First Aider training to ensure that all state-funded schools, sixth form and further education colleges within London have access to one by 2021. The training will give school staff the skills and confidence to spot the signs of poor mental health and guide a young person through mentally distressing situations.
Through the Young Londoners Fund, I’m also funding projects to improve the mental health and wellbeing of their students. For example, a Haringey project between the local College, Pupil Referral Units and schools to support over 200 young people a year through mentoring and access to psychotherapy; and a Hounslow project run by disability charity Ruils to support 450 young people with complex needs.

Widening the benefits of sector led improvement in public health

Onkar Sahota: A two-year programme to improve stop-smoking services has resulted in a new model tendered across London, according to a paper from the LGA. What steps are you taking to capture these benefits in other parts of the public health system?

The Mayor: Throughout the development of my Health Inequalities Strategy, I have been impressed by the many innovative initiatives being led by London’s public health teams. Ensuring this learning is being widely shared will be crucial in improving the health of Londoners and reducing health inequalities.
This is why the GLA works with the Association of Directors of Public Health (ADPH) London to support their facilitation of Sector Led Improvement by local public health teams. Along with the work you mention on tobacco, this has included in-depth thematic reviews on alcohol and child obesity. Future work is being planned in relation to children and young people. These reviews incorporate the development of a self-assessment framework, peer review, and delivery of an action plan which is evaluated one year on. My officers will continue to offer advice and support to this work, which by its nature is locally led.

Community health workers

Onkar Sahota: The Journal of the Royal Society of Medicine published a study, “Integrating a nationally scaled workforce of community health workers in primary care”, modelling the impact of a programme of health outreach workers. It concluded this would support general practice and help integrate services. What assessment have you made with health partners of the feasibility and desirability of piloting a similar model in London?

The Mayor: In December, Dr Jonty Heaversedge updated the London Health Board on London’s new primary care strategy which includes reference to significant workforce challenges in recruitment and retention, and the opportunity of greater skills mix. The strategy also acknowledged the importance of collaboration to deliver improved services, and a focus on London’s workforce through devolution.
In addition, the recently-published NHS Long Term Plan gives priority to primary and community care and the health and care workforce, which I am sure will be helpful in progressing London’s strategic approach.
I will ensure that Dr Heaversedge is aware of this report and will ask that he includes an assessment of the Royal Society of Medicine’s proposals as part of a future update to the LHB.

Healthy Early Years Providers

Jennette Arnold: How many providers have registered for the Healthy Early Years scheme?

The Mayor: At the beginning of January 2019, 856 providers had registered with Healthy Early Years London.
Further information on the scheme is available at https://www.london.gov.uk/what-we-do/health/healthy-early-years-london.

Stop the rot: stopping inappropriate dental fines

Onkar Sahota: The number of fines issued to people in London who allegedly misused free NHS dental provision more than doubled from 2015/16 to 2016/17, reaching 155,000. On appeal, nine out of ten fines are overturned and under a third are ever paid.
Do you agree that it is inappropriate and ineffective for the NHS to spend time and money scaring people away from getting what they are entitled to, and will you ask the NHS in London to issue new guidance on dental fines that reduces this problem?

The Mayor: Dental services are vitally important to Londoners, especially children and young people. My Health Inequalities Strategy calls on partners to take further action on improving child oral health, including access to dental care, particularly targeted on those communities least likely to be registered with, or regularly visit, a dentist.
I am keen to ensure all Londoners have access to appropriate health services, and any barriers to access would be an issue of concern to me. I will support partners efforts to promote access to dental services, however, my powers in relation to the NHS are very limited. Responsibility for dental fines sits with the NHS Business Services Authority, and I will ask officers to write to them seeking clarification of the situation.

NHS Trusts

Tony Devenish: Are you concerned that one in four NHS Trusts have spent no money on cyber security in the last year? Do you know how many London Trusts fall in to this category and what are you doing to assist with resilience?

The Mayor: Cyber security is a growing concern across the public sector, including in the NHS. The GLA Group and London’s wider public services need to be resilient in the face of cyber-attacks, and Government needs to ensure that public services have the resources and expertise they need to achieve this.
At the GLA a new approach for cyber security is in development and this will involve discussions with the London Resilience Partnership and the NHS.
As part of this, the GLA held an event at City Hall in December to discuss London’s cyber security needs with a range of public sector organisations and partners, including NHS trusts.

Increasing Participation in Healthy Early Years

Jennette Arnold: How are you increasing participation in Healthy Early Years?

The Mayor: The scheme has been very well received by practitioners and people working on early years strategy in Boroughs, many of whom have been involved in the programme’s development through the HEYL Strategic Advisory Group. It was launched at one of my Early Years Education Hubs with Merton Council and the NHS in October.
My Healthy Early Years London (HEYL) Team provide support to boroughs and settings through the healthy early years network, and through training, borough visits, email and telephone support, and through the website and communications support. The team also work closely with my Early Years Education Hubs, Public Health England London, and London’s Ofsted inspectors to promote the programme.

Pre-Exposure Prophylaxis (2)

Tom Copley: What pressure can the Mayor, through the London Health Board, place on NHS England and local authorities to ensure no one is turned away from accessing the Pre-Exposure Prophylaxis Trial in London?

The Mayor: I know that there is high demand for PrEP and I welcome the recent news that the trial researchers have submitted a case for increasing trial places from 13,000 to up to 26,000, and that NHSE has committed to fund additional places in line with existing trial funding arrangements. I understand that local authorities have called on NHSE to use the savings made by switching to a generic drug to help them bear the trial associated service costs.
Taking action on HIV is a priority in my Health Inequalities Strategy and last year I signed London up to the Fast Track Cities Initiativewith the aim of ending new HIV infections by 2030. If we are to achieve this then rapid implementation of evidence-based, cost-effective prevention to everyone who could benefit must be the priority. I have therefore written to the Secretary of State for Health and Social Care to make PrEP available to everyone who could benefit and to reverse the planned cuts to the public health budget so that local authorities can meet the costs related to attendance and testing at sexual health clinics,
Progress on the London Fast Track Cities initiative is reported to the London Health Board via the London Prevention Partnership Board, and I am confident the Board will expect the initiative to look at how to promote the uptake of PrEP among Londoners who are at risk of infection as part of an evidence-based combination prevention approach.

Pre-Exposure Prophylaxis (1)

Tom Copley: How important is ensuring access to Pre-Exposure Prophylaxis as a means to end future HIV infections in London?

The Mayor: The evidence shows that Pre-Exposure Prophylaxis (PrEP) is highly effective for preventing HIV in groups at high risk of infection, if used as prescribed, and could be a gamechanger in the work to eliminate new HIV infections.
There has been a substantial decline in the number of people diagnosed with HIV in London over the past two years, and this decline seems due to a combination of HIV prevention efforts including correct and consistent condom use, early diagnosis through testing, and prompt initiation of treatment that stops onward transmission. It is therefore important that communities are made aware of both PrEP and other HIV prevention methods.
I welcome the recent commitment by the Secretary of State for Health & Social Care to make the UK the first country in the world to have no new cases of HIV by 2030. However, if this is to happen then a key priority must be the rapid implementation of evidence-based, cost-effective prevention and treatments to everyone who could benefit. I am therefore calling on him to make PrEP available to everyone who is at risk of HIV infection. Full rollout would allow PrEP to be promoted more widely to groups currently restricted by the NHS Impact Trial protocol.
Local authorities would support PrEP as part of an effective HIV prevention strategy but they are understandably concerned about how they meet the costs related to attendance and testing at sexual health clinics. I am therefore also calling on the Secretary of State to reverse the planned cuts to public health grants as a matter of urgency.

Self-build (2)

Tom Copley: What steps are you taking to support boroughs to make self-build plots available to those who would like them?

The Mayor: My Small Sites, Small Builders programme helps boroughs and other public landowners to bring forward small sites they own for groups including community-led organisations and self-builders. I am also funding the London Community-Led Housing Hub which helps connect residents and boroughs about potential projects, including those that involve self-build.

Green Alliance Report (3)

Leonie Cooper: Will the Homes for Londoners‎ Board discuss the Green Alliance report, and will there be expectations that Housing Associations receiving Mayoral Housing funding will take it into consideration in their construction activities?

The Mayor: I support many of the points raised in the Green Alliance report, and my Homes for Londoners Board recently discussed the use of off-site construction which the report recommends. When developing the terms of future affordable housing investment programmes, my team will consider what measures referenced in the report can be made an expectation of housing associations receiving funding.

Londoners Said recommendations

Onkar Sahota: Thrive LDN’s recent paper “Londoners Said” made ten recommendations based on a set of city-wide conversations about mental health. What progress have you made on these and what steps do you have planned to take them forward in the future?

The Mayor: Thrive LDN and the Mental Health Foundation delivered 17 community conversations across a number of London boroughs, attended by over 1,000 Londoners. Each borough received a report following their conversation to frame next steps and local action, and the Thrive LDN team is supporting several borough-based initiatives as a result.
The recently published Londoners Said report provides a London-level analysis of all conversations was tabled at the London Health Board on 18th December 2018. It makes ten recommendations for action and change. Implementation of the recommendations will form a core part of Thrive LDN’s strategy over the next two years. Philip Glanville (Mayor of Hackney and Political Lead for Thrive LDN) and I have agreed to write a joint letter to all London Council Leaders to raise awareness of the report and urge them to consider how they can work with Thrive LDN to take these recommendations forward in their local areas.

Public health laboratory capacity

Onkar Sahota: Since December 2016, London’s public health laboratory, previously at St Barts, has been closed and its staff redeployed across the south east. The Lead Public Health Microbiologist post has been vacant since 2016 and the London regional virologist post since June 2018.
Do you agree that London requires a city-based, 24/7 public health lab, and will you write to Public Health England asking a) what risk assessment they made of their decision to disestablish the London facility and b) what plans they have for the city’s future needs in this department?

The Mayor: My statutory health advisor, Professor Yvonne Doyle, has assured me that the London population is currently well served in relation to public health through the public health laboratory in Cambridge. This arrangement was put in place as an interim measure when the public health laboratory in London left Barts Health NHS Trust.
Plans are underway to reintroduce a laboratory based in London. I understand that the provision of expert microbiological advice has not been compromised by the relocation of the consultant and biomedical staff, and will keep the matter under review through my regular meetings with Professor Doyle.

Private rented sector regulation

Tom Copley: More than a quarter of London households now live in the private rented sector, and more private rented homes fail to meet the decent homes standard than any other tenure. While I’m sure you will welcome the passing of the Homes Fit for Human Habitation Act, what further steps must the Government take to improve conditions for London tenants?

The Mayor: I welcome the Homes Fit for Human Habitation Act, but the Government must ensure this Act forms part of a strategic overhaul of the private rented sector. In the outline of my London Model for tenancy reform, I have called on the Government to introduce open-ended tenancies and to end ‘no fault’ Section 21 evictions. Alongside this, I believe London needs a strategic approach to rent stabilisation and control, and the Government must ensure that councils have the powers and resources to improve standards through enforcement action against rogue landlords and letting agents.

Consulting trade unions on the future of London healthcare

Onkar Sahota: In the first half of 2019 you are due to publish your final social prescribing vision, and the London Health Board will consult on a refreshed Health and Care Vision for London. What steps have you taken, and will you go on to take before publication, to ensure the views of recognised NHS trade unions are represented in the eventual output?

The Mayor: I have recently published a draft Vision for Social Prescribing, which outlines the GLA and the NHS’ proposed approach over the next 10 years. Views on the proposals are currently being sought from a wide range of stakeholders, including Unison, Unite, GMB, Royal College of Nursing and other NHS trade unions.
The London Health Board will receive the draft London Health and Care Vision at its April meeting, including an outline of proposals for engagement.

Update on Health Inequality Strategy implementation plan

Onkar Sahota: In the HIS implementation plan, the Mayor committed to:
Fund work in 2018/19 to support the development of effective evaluation and outcomes measurement and the further development of sustainable social prescribing models; and

		

Fund work in 2018/19 to explore how digital solutions might support the effective roll-out of social prescribing, and how to obtain the more specialist social welfare advice people need but is increasingly difficult to access.
Please can you provide detail of a) how much funding has been allocated for each of these commitments, b) what work has been commissioned, and c) when the results of each of these projects will be reported.

The Mayor: My draft Vision for Social Prescribing, published in December – on which we are currently seeking feedback - outlines our priorities over the next 10 years.
In 2018/19 I have so far commissioned several projects exploring social prescribing in London to inform the Vision.
Reviews of the digital landscape, and the of role of the voluntary sector (£36,000 combined) have already been published and are available at https://www.london.gov.uk/what-we-do/health/social-prescribing
I also commissioned an internal review of the role of local government (£10,000).
I have recently commissioned three projects (£10,000 each) to inform the evaluation work programme, and I have commissioned the Housing Association Charitable Trust to look at the role of housing associations (£10,000). These reports will be available in spring 2019. I am also in the process of commissioning a review of the current provision of social welfare legal advice in London.

Capita’s cervical screening test disaster

Onkar Sahota: NHS England has said more than 50,000 women have missed a cervical screening test because Capita failed to notify them. Has the NHS ascertained how many of these women are London residents, and if so, what are the relevant figures?

The Mayor: This is obviously a concerning incident. I understand from NHS England’s London office that all women affected have now been contacted with the next steps for their care, and their GPs informed of the situation. Whilst there is no current evidence that this incident has led to harm to the women involved, NHS England will undertake a full audit of screening outcomes for these women in nine months’ time.
At this stage it is estimated that around half of the women affected either live in London or are registered with a London GP practice. NHS England will advise on the number that are London residents as soon as this is confirmed.
I will raise this issue with my statutory health advisor, Professor Yvonne Doyle.

Cressingham Gardens

Florence Eshalomi: Many of my constituents on the Cressingham Garden Estate in Lambeth are incredibly concerned that the Mayor has green-lighted Lambeth Council’s ‘regeneration’ plan for the estate. As he will be aware, the plan is not supported by residents. Would the Mayor agree to review this application in light of their concerns?

The Mayor: No planning application for regeneration at Cressingham Gardens has been submitted. If the scheme is submitted for planning, the Mayor will review plans to ensure their compliance with his planning policies.
Lambeth council received a funding allocation from the GLA toward new homes at Cressingham Garden in July 2017. The council’s plans to use this allocation are routinely reviewed by GLA officers.